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The diary records Rush's travel, accompanied by a servant and via horses, between the outskirts of Philadelphia and Carlisle, Pennsylvania, for an initial meeting with the trustees of Dickinson College. During the meeting the Trustees selected Dr. Charles Nisbet to serve as the College's first president. Rush described the taverns and other travel lodges at which he stopped, along with Tavern staff and other patrons, the quality of the food and drink, along with conversations he witnessed or took part in. Discussion often centered on the topics of the Constitution, paper money, as well as Dickinson College. Rush also described the results of a rapid Spring thaw on the Susquehanna River, the unusually cold weather, the scenery, and the presence whiskey stills in Irish settlements and their impact on their communities.

Rush not only detailed her religious thoughts and practiced devotional exercises but also outlined her feelings regarding family matters, especially in regard to her bereavement following her husband's death. She requested intersession for family members, such as when her daughters emigrated to England and Canada and their later return, when they suffered serious illnesses, and blessings for the christenings of her grandchildren. She also noted her general physical and mental health as she aged. Entries are irregular, but often annually mark the New Year and her birthday on March 2nd.

In the casebook, Rush provided brief histories for his treatment of about 75 individuals. Entries generally included the year, patient's name, presented medical issue, dates of treatment, prescriptions applied, pulses noted, and the progression or resolution of the problem. Rheumatism was the most common complaint, along with dropsy (edema), pneumonia, diarrhea, and mania. Among the other illnesses listed were palsy (paralysis), fever, typhus, epilepsy, consumption, scurvy, hydrothorax, swelled spleen, and hysteria.